Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas
Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas
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切除范围和辅助放疗对高级别脑膜瘤现代治疗的生存影响
DOI：
10.1007/s11060-019-03278-w
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发表时间：
2019-10-01
影响因子：
3.9
通讯作者：
Chen, Zhongping
中科院分区：
文献类型：
--
作者：
Li, Depei;Jiang, Pingping;Chen, Zhongping
目的根据现代诊断和治疗方法，探讨高度恶性脑膜瘤(WHO分级II~III级)的手术切除范围和辅助放射治疗对患者生存率的影响。方法对2000-2015年间在监测流行病学和最终结果(SEER)数据库中发现的高度恶性脑膜瘤患者进行生存分析。采用倾向性得分匹配(PSM)方法减少选择偏差。另92例来自中山大学癌症中心(SYSUCC)的患者用于验证。结果SEER纳入患者530例。大部切除(GTR)和大部切除(STR)患者的总存活率(OS)无显著差异，即使在实施PSM后也是如此。多因素分析发现，年龄65岁(HR2.22，P<；0.001)、肿瘤直径6 cm(HR1.59，P=0.004)和III级肿瘤(HR4.31，P<；0.001)与OS相关。分层分析显示，无论切除范围如何，辅助放射治疗可显著改善III级脑膜瘤的OS，但对II级脑膜瘤则不显著。在SYSUCC队列中，切除范围与OS也没有显著相关性。然而，移植物抗宿主病(Simpson分级I-III)患者的无进展生存期(PFS)明显高于短暂性耐药组(P<；0.001)。此外，对于GTR后的II级脑膜瘤，放疗不能改善OS和PFS。结论在高级别脑膜瘤的现代治疗中，GTR并不能改善OS，但似乎与PFS的增加有关。放射治疗作为III级脑膜瘤的辅助治疗是合理的，但其对II级脑膜瘤的疗效仍不确定，需要通过前瞻性研究进一步验证。
Purpose We aim to investigate the impacts of extent of resection and adjuvant radiotherapy on survival of high-grade meningiomas (WHO grade II-III) according to modern diagnosis and management. Methods Patients with high-grade meningiomas were identified in the Surveillance Epidemiology and End Results (SEER) database between 2000 and 2015 and used for survival analysis. Propensity score matching (PSM) was conducted to reduce selection bias. Another 92 patients from Sun Yat-sen University Cancer Center (SYSUCC) were used for validation. Results 530 patients were enrolled from SEER. Patients with gross total resection (GTR) had no significantly different overall survival (OS) compared with those with subtotal resection (STR), even after performing PSM between these two groups. Multivariable analysis found that age >= 65 years (HR 2.22, P < 0.001), tumor diameter > 6 cm (HR 1.59, P = 0.004) and grade III tumor (HR 4.31, P < 0.001) were associated with worse OS. Stratification analysis showed that adjuvant radiotherapy conferred significantly improved OS for grade III meningiomas, but not for grade II meningiomas, regardless of resection extent. In SYSUCC cohort, resection extent was also not significantly associated with OS. However, patients with GTR (Simpson grade I-III) had distinctly increased progression-free survival (PFS) than those with STR (P < 0.001). Additionally, for grade II meningiomas after GTR, radiotherapy was unable to improve OS and PFS. Conclusion On modern management of high-grade meningiomas, GTR does not improve OS, but seems to be associated with increased PFS. Radiotherapy is reasonable as a supplement for treating grade III meningiomas, whereas its effect for grade II meningiomas remains uncertain and needs further validation by prospective study.